Abstract
BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) strains are prevalent in healthcare and the community. Few studies have examined MRSA carriage among medical students.The aim of this study is to examine Staphylococcus aureus (SA) carriage, and particular MRSA, over time in cohort medical studentsMethodsProspective collection of nasal swabs from medical students in Israel and assessment of SA carriage. Three samples were taken per student in preclinical and clinical parts of studies. Antibiotic susceptibilities were recorded and MRSA typing was performed by staphylococcal cassette chromosome mec (SCCmec) types, Panton Valentine Leukocidin (PVL) encoding genes, and spa types. Clonality was assessed by pulsed-field gel electrophoresis.ResultsAmong 58 students, SA carriage rates increased from 33% to 38% to 41% at baseline (preclinical studies), 13 and 19 months (clinical studies), respectively (p = 0.07). Methicillin-susceptible SA (MSSA) carriage increased in the clinical studies period (22 to 41%, p = 0.01). Overall, seven students (12%) carried 13 MRSA isolates. MRSA isolates were PVL negative and were characterized as SCCmecII-t002, SCCmecIV-t032, or t12435 with untypable SCCmec. MRSA carriage during the pre-clinical studies was evident in 4/7 students. Two students carried different MRSA clones at various times and persistent MRSA carriage was noted in one student. Simultaneous carriage of MRSA and MSSA was not detected.ConclusionsMSSA carriage increased during the clinical part of studies in Israeli medical students. Compared with previous reports, higher rates of MRSA carriage were evident. MRSA strains were genotypically similar to Israeli healthcare-associated clones; however, carriage occurred largely before healthcare exposure, implying community-acquisition of hospital strains.
Highlights
Methicillin-resistant Staphylococcus aureus (MRSA) strains are prevalent in healthcare and the community
These strains were usually non-MDR, carried small staphylococcal cassette chromosome mec (SCCmec) elements, mostly types IV and V, and carried the genes encoding the Panton-Valentine leukocidin (PVL), a pore-forming toxin rarely found among SA isolates [1]
In a nonsystematic review of the English literature we found several studies, conducted worldwide, investigating SA carriage among medical students (Table 1) [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32]
Summary
Methicillin-resistant Staphylococcus aureus (MRSA) strains are prevalent in healthcare and the community. The aim of this study is to examine Staphylococcus aureus (SA) carriage, and particular MRSA, over time in cohort medical students. Beginning in the late 1990s, community-associated strains of MRSA (CA-MRSA) were described with increasing incidence, colonizing and infecting patients who had no recent contact with the healthcare system. These strains were usually non-MDR, carried small SCCmec elements, mostly types IV and V, and carried the genes encoding the Panton-Valentine leukocidin (PVL), a pore-forming toxin rarely found among SA isolates [1]. In many geographic regions there are no longer lineages, genetic markers, or susceptibility phenotypes that are indicative for specific epidemiological origins such as HA-MRSA or CA-MRSA [1]
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